Provider Demographics
NPI:1235158262
Name:MILAN L HOPKINS, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MILAN L HOPKINS, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-220-9064
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:UPPER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95485
Mailing Address - Country:US
Mailing Address - Phone:707-275-2366
Mailing Address - Fax:707-275-9043
Practice Address - Street 1:9425 MAIN ST
Practice Address - Street 2:
Practice Address - City:UPPER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95485-9602
Practice Address - Country:US
Practice Address - Phone:707-275-2366
Practice Address - Fax:707-275-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC344060208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C344060OtherMEDICAL